Litherland J C, Evans A J, Wilson A R, Kollias J, Pinder S E, Elston C W, Ellis I O, Yeoman L J
Breast Screening Training Centre, Nottingham City Hospital, UK.
Clin Radiol. 1996 Aug;51(8):562-5. doi: 10.1016/s0009-9260(96)80136-x.
The UK breast screening Surgical Quality Assurance guidelines suggest a target for pre-operative diagnosis of screen detected cancer of over 70%. Core biopsy was introduced in our breast screening assessment clinics in April 1994 and this study reports the impact of introducing core biopsy on the pre-operative diagnosis rate. Between April 1994 and March 1995, 100 cancers were detected. Results of fine needle aspiration cytology and core biopsies were studied to assess the contribution of each to the pre-operative diagnosis rate of cancer and comparison made with results from the previous 2 years. After introducing core biopsy pre-operative diagnosis rates rose from 72% to 90% (P < 0.0002) leading to a 64% reduction in diagnostic biopsies for screen detected cancer. Malignant results were obtained in 61% of first FNA (similar to previous years) and 74% of first core biopsies (combined 87%). Repeat FNA/core diagnosed three further cancers increasing the final pre-operative diagnosis rate to 90%. Final pathological examination after surgical excision demonstrated an increase in the preoperative detection of DCIS from 39% to 82% (P < 0.01) and invasive disease from 80% to 92% (P < 0.02). The introduction of core biopsy has significantly improved our management of screen detected breast cancer.
英国乳腺癌筛查手术质量保证指南建议，筛查发现癌症的术前诊断目标应超过70%。1994年4月，我们的乳腺癌筛查评估诊所引入了粗针活检，本研究报告了引入粗针活检对术前诊断率的影响。1994年4月至1995年3月期间，共检测出100例癌症。对细针穿刺细胞学检查和粗针活检的结果进行了研究，以评估每种检查对癌症术前诊断率的贡献，并与前两年的结果进行比较。引入粗针活检后，术前诊断率从72%升至90%（P<0.0002），导致筛查发现癌症的诊断性活检减少了64%。首次细针穿刺活检（FNA）的恶性结果为61%（与前几年相似），首次粗针活检的恶性结果为74%（两者合计为87%）。重复细针穿刺活检/粗针活检又诊断出另外3例癌症，使最终术前诊断率提高到90%。手术切除后的最终病理检查显示，导管原位癌（DCIS）的术前检出率从39%增至82%（P<0.01），浸润性疾病的术前检出率从80%增至92%（P<0.02）。粗针活检的引入显著改善了我们对筛查发现的乳腺癌的管理。
